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Bitter Sweet Symphony

March 17, 2015

A guest blog by Florian Nightingale

A touch over six months has passed since I took the tentative first few steps down my career path as a registered nurse in emergency care settings. A lot has happened over that time; I’ve learned a lot and grown up a lot. The things I have learned have been about me, about nursing and about working in my current environment. Sadly not all of the things I have learned about nursing have been pleasant things. However, that is something for another time, another day.

I’ve picked up many practical skills, such as cannulation, phlebotomy, IV medication administration to name but a few. In terms of my clinical abilities, these have been enhanced by those skills I already had; however my judgement has become somewhat more attuned to emergency care. I’ve mentioned in previous blogs how I feel I’ve had to compromise the nurse I’d like to be for the one I need to be to survive in emergency care settings. I’m also developing my other interests in emergency care through various means that are available locally. Additionally, I am getting to do a fair old bit of simulation, which is good fun and an excellent training opportunity not just for myself but also for the medical students and soon-to-be-nursing students that I will be doing it with.

In terms of learning about myself, I’ve learned that I’m exceptionally capable of beating myself up and taking things to heart far too easily. I need to toughen up a bit somehow. I’m a harsher task master on myself than perhaps I ought to be. I push myself harder and harder to learn new things to make me better but it just feels like nothing is going in and well – that stings. I seem to rest very little as well.

What have I learned about nursing? Well, I think part of the biggest thing I have learned and one of the most disappointing things is that we aren’t as progressive here in the UK as we might like to think. I don’t think we’re allowed to learn what has been considered traditionally to be more advanced skills. We seem quite often to want to go back to the “good old, bad old days” because we have quite a thing for nostalgia in the UK.

This is something of a handicap to nursing. We need to be more up-skilled from the earlier points in our career. Evidence shows a direct correlation between patient outcomes and the standard of nurse education. I do in a way feel that I am playing catch up a lot with my learning but this is partly because I’m pushing myself harder than I really should – but only because I’m trying to be better at my job. I also hate being restricted by what other people think I should or shouldn’t do as a nurse – because I am a nurse.

In a few years I’m seriously considering retraining so I can become more independent in a different role. As much as I enjoy nursing, if it isn’t moving the way I want it to and as quickly as I’d like it to, then I’m going to be thinking very hard about leaving. It pains me greatly to say that six months into my career but sadly this is how I feel.

There is a genuine need for nurses within the UK to be more skilled in physical assessment. This is especially true where I work, when, owing to the number of admissions waiting to be clerked, a patient might be waiting a long time to be assessed. As much as experience gained over the past few months has helped me develop how I assess people, simply relying on a MEWS score and gut feeling isn’t helpful when triaging needs and clinical priorities. Additionally these are very subjective things; my experience is limited and having more skills and more facts to back me up would give me more confidence in my judgement and skills.

To sum up then, the past few months have been something of a bitter sweet symphony. As much as I am now a much better nurse than I was to start with, I feel there is a long way to go and to some extent I am disappointed by the realities of nursing when compared to what I thought it would be. More than anything, I’m disappointed that I can’t really be what I want to be. What I take consolation in, is that I have greatly improved and this has been confirmed by my managers. As I’ve said, it’s been a bitter sweet few months. For the most part is has been good but there are some bad after tastes.

  1. Barbara Bradbury, Halland Solutions permalink

    I am wondering why you are disappointed in your chosen career, only 6 months post qualifying? What did you think nursing entailed before you selected it as a career? Of course you have learnt much in your first 6 months, and realise that there is a great deal more for you to learn. Did you think you were going to go from novice to expert in that time?
    I had a very interesting discussion with a group of Band 6 nurses this morning. They have been qualified between 2 and 4 years and I asked why there was so much sickness absence these days. In my day if the good old and not bad old days, it was unheard of. I can’t believe that we were healthier then than now . They told me:
    The majority of people go into nursing because it is an easy degree and a job at the end of it, with not massive debt like other students;
    People lack passion. They do not enter the career to care for people. Many of them don’t have a clue what it means to care;
    Because they lack passion, they lack compassion;
    Many students think that they will become an Agency nurse after qualifying.

    I asked why there were so many drug errors these days. They said:
    Their exam was a multiple choice paper with a pass mark of 60%. This means that, out of 10 patients, it is deemed acceptable to have 4 drug errors. Students believe that it’s OK to have drug errors and take that attitude with them when they qualify.

    One of these nurses in the group told me that, if it had been down to her, she would have employed only 4 nurses that she had interviewed in 4 years, such was the quality of the applicants.

    The group also acknowledged that there were excellent nursing students – so it is not all doom and gloom. However, after qualifying they are like students and need a huge amount of support in their first 6 months to a year, because they are inadequately prepared to nurse.

    Now, I do realise that nurses now are expected to do tasks that used to be the province of HOs and SHOs. However, this should not be confused with nursing. These are tasks that medics now don’t have time for and, as usual, nurses take them in because that is what nurses do.

    If you want to be a doctor or paramedic, then go and get qualified in those. However, it fascinates me that people are now entering medicine through the back door.

    However, that said, nursing needs its flag bearers. I am one.

  2. Take heart…

    At the six month point, it is natural to question what it’s all about, even to be suffering from a bit of burnout. You’ve barely had the time to take a step back. This is normal. All in all, being a nurse is an alternately rewarding and frustrating business. Sometimes a hellish and unnecessarily complicated one. We are increasingly expected to take on doctors’ roles, without the pay or the accompanying respect. As a new nurse, a lot is expected of us, yet we frequently don’t get, or have to fight, for the support to help us realise those expectations or take them further. Emergency care is a particularly intensive first introduction to nursing. However, you may look back in a few years and realise it was probably one of the best places to start your career in terms of the exposure, variety and trust you are afforded. You really need to give it a couple of years at least. You also need to work in a few different areas before you can genuinely say nursing has been a disappointment, or that it’s not for you. I’m always surprised by the number of people who just stay in the same area all their careers and think they know all there is to know. For others it’s about staying with their mates or keeping within their comfort zone. Nevertheless, whatever makes you happiest.

    Whilst a lot is expected of you, I do think your own expectations (and the expectations of many new nurses/students) are too high. Like the commenter said above, I suspect you are a tiny bit confused as to the actual role of a nurse. Do you want to be a nurse, a physician’s assistant, a doctor, or something else entirely? Like many new nurses/students (and active blogger) you may also be suffering from the modern disease of too much information, which again builds up expectations to unhealthily high levels. The competitive and bragging nature of social media doesn’t help by putting extra pressure on people to get ahead or feel like they are missing out or lacking in some way. I remember being 7 years old and so desperate to learn to swim (and reading so many books on my swimming heroes) that one day I just threw my self in, without being actually able to swim! Totally unrealistic. Having performed very well academically, many new nurses tend to struggle with the boring, repetitive and unimaginative practicalities of being a nurse and being ordered around by others who may be less than inspiring and imaginative. It’s less about changing the world and more about changing the dressings and other mundane stuff. It’s important and character forming to go through, but it can be a big come down.

    On one hand you crave more skills, yet you express a slight lack of confidence in yourself and your skills and abilities. You don’t actually say what you would ‘like to be’, other than ‘independent’. This suggests to me that your stresses are largely due to working with other people or in the acute setting. Do you feel a valued member of your team? Or would you prefer to be more of a lone worker? If it’s the latter, then you will struggle in a hospital environment because it’s all about team and the bigger picture, no matter how inclusive that team might turn out to be. Bear in mind that being a doctor or something else could just as easily not turn out what to be what you thought it would be. However, there are lot’s of great roles out there available to you once you’ve covered a bit of varied ground, e.g nurse endoscopist, nurse anaesthetist, surgeons assistant, perfusionist, researcher, combat medic, transfer nurse, teacher/trainer etc etc. All much more independent roles, some with added kudos, but none of which I would properly describe as being a ‘nurse’. Why just stick to one role, why not mix it up with a couple of different roles? The NHS is not the only, or the best healthcare system you can work in either. A few years experience and the world really could also be your lobster : )

    Perhaps start by writing down ‘what’ you would like to be, then go find that role. It may not be what you could describe as the role of a nurse….

    1-2-3… back in the room.

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